Communicable diseases have been brought under control throughout the world by various measures such as adequate public health care, immunisation, health awareness, the invention of various antibiotics and newer management strategies. The urbanization of socio-economic changes has helped to curb the incidence of communicable diseases. But, the last century has shown a remarkable increase in the Non-Communicable Diseases (NCD). Diseases like Obesity, Diabetes Mellitus, Hypertension, Coronary Artery Disease, Brain strokes, Dyslipidaemias, Cancers, Lung diseases, Sleep Apnoea, Thyroid abnormalities and various kidney diseases have caused significant morbidity and mortality.
The current global death toll due to NCDs and their complications is more than 17.3 million per year. The NCDs are called lifestyle diseases as they are primarily based on day to day habits that lead the person towards an unhealthy lifestyle. These diseases become a major health and economic burden in developing countries including India. Sedentary lifestyle, increase in screen time, consumption of calorie-dense food, increased stress, fast track life, and genetic orientation become the main factors dragging Indians towards NCDs. In India, a large percentage of people are physically inactive with fewer than 10% engaging in recreational physical activities. Lack of physical activity, including participation in outdoor games, has been reported even in school-going children in South Asian countries.
According to epidemiological studies, it is apprehended that Indian subcontinent will have to bear more than half of the burden of risk and eventuality of NCDs, in the coming days. It is feared that India will be the global capital of Diabetes Mellitus by the year 2030. South Asians not only have a higher risk of premature Coronary Artery Disease(CAD) but also the disease is more severe. In India CAD manifests almost a decade earlier than in western countries. The deaths from CAD in India are doubled in the past ten years.
The prevalence of hypertension in the late ninety to early twentieth century varied among different studies in India and ranges from 2-15% in urban India and 2-8% in rural India. The prevalence increased over in six decades to 25% in urban and 15% in rural India and is showing an increasing trend day by day. The increasing prevalence of high normal BP has been seen in many recent studies at around 32-40%. Moreover, 30-35% of hypertensive patients are detected to have co-existing diabetes mellitus which results in increased cardiovascular morbidity and mortality. In the meta-analysis of multiple cardiovascular epidemiological studies, it was reported that prevalence rates of CAD and stroke have more than trebled in the Indian population. The National Family Health Survey 2019-2020 (NFHS-5) which shows our State facts sheet also reveals the increasing trends of the NCDs.
Importance of screening in early detection and treatment
Unfortunately, most of the non-communicable diseases are silent killers as they remain asymptomatic for a long time and are diagnosed when the patients develop complications. This can be taken care of by way of screening. Screening is defined by the world health organisation (WHO) as “services for the presumptive identification of unrecognised disease in a healthy, asymptomatic population by means of tests, examination, or other procedures that can be applied rapidly and easily.” Screening is important for diseases where metabolic and organ complications develop much before symptoms manifest. Screening not only involves early diagnosis but also gives a comprehensive plan for the full evaluation, education and management strategies.
Screening can be either population-based or individualised. Individual screening is an opportunistic screening wherein the individual comes in contact with the health care system which in simple words is a health check-up. The growing epidemic of diabetes and various other NCDs in India can be diagnosed and controlled by a systematic opportunistic screening i.e. health check-ups.
Prevention is better than cure
The present pandemic has revealed that the high death rate was amongst those who had other morbidities. The common ones being Diabetes Mellitus, Hypertension, Pulmonary diseases, Immunodeficiency states, Cancers, Liver, and Kidney Diseases. Apart from senior citizens, the COVID-19 took a toll of younger patients due to these comorbid conditions. We all should strive towards a goal of a healthy life as this year the fittest survived the COVID attack. We all know that prevention is always better than cure. We can say that this can only be achieved by way of keeping one’s health card updated by regular health check-ups.
(The writer is an Internal Medicine Consultant, at Manipal Hospitals “ Goa)
